Buprenorphine

Faced with Medicaid's low payments and bureaucratic red tape, some Maryland doctors are reluctant to prescribe buprenorphine for heroin addicts, even though the drug has been promoted as a potential magic bullet in the war against addiction, according to a survey set for release today. The survey, commissioned by the Center for a Healthy Maryland Inc., found that doctors were not always sufficiently reimbursed for their time and services and that there were other "hassles," including medication preauthorization, a process that in some cases can take 48 hours, and varying and confusing protocols among Medicaid providers.

It is mid-morning on a recent Friday in West Baltimore, and there is a long line snaking down the street and around the corner. Why? Vendors are dispensing free heroin samples. In other areas of the city, buyers are risking arrest and drug contamination to illegally purchase buprenorphine. It is legal medication when given with a prescription. It is used to treat opioid addiction and facilitate recovery. So why buy it illegally? Not to get high as a substitute for heroin. They are using it to treat their heroin addiction.

Port Louis, MAURITIUS -- The sun set hours ago. Most everyone who sang and prayed in this concrete room with curtains that's still stuffy from body heat have gone home. Christabelle Piangnee, a 29-year-old whose life has become an incongruous mix of opiates, prostitution and thoughts of quitting both, stays behind and makes a confession of sorts. "I have it," she says. She means HIV. She doesn't say more. She simply sits in her black leather jacket, her open sandals revealing painted toenails, her pretty face a picture of fatigue and hopelessness.

University of Maryland pharmacologist Carrie John died from an allergic reaction and not because she injected a seemingly tainted batch of the narcotic buprenorphine, according to the state medical examiner. "There was nothing in her system to cause her death, no drugs," said Dr. Zabiullah Ali, the pathologist who investigated her death Sept. 27. "It was an allergic reaction to something she injected," Ali said Thursday in response to questions from The Baltimore Sun. "But what it is, we don't know."

BUPRENORPHINE is a tongue twister. Never mind. This opiate blocker, which federal authorities are introducing in 14 cities, including Baltimore, offers unusual promise in helping stabilize heroin users' lives and getting them started on the path to recovery. Moreover, for the first time, primary care physicians will be able to address abusers' detoxification and withdrawal needs during regular office visits. Buprenorphine is no miracle cure, nor is it suitable for all heroin users. Yet its arrival is a blessing, because it presents a new treatment option for heroin addicts wanting to break the habit.

The addiction treatment drug buprenorphine will come under closer scrutiny through a new federal initiative to track the deaths of opiate addicts taking it or methadone. U.S. Substance Abuse and Mental Health Services Administration officials hope the new tracking system will significantly improve the safety and quality of drug treatment for more than 400,000 addicts across the country, including thousands in Baltimore. A series of articles published in The Sun in December showed that while buprenorphine can be a highly effective addiction medicine, misuse of the drug is on the rise.

Police seizures of buprenorphine increased rapidly in Baltimore City and County in 2007, the same year that local and state government began spending millions to expand use of the narcotic to treat opiate addicts, police drug lab data show. The numbers provide evidence of growing illegal sales and abuse of buprenorphine, a trend seen nationally. This month in Wise County, Va., authorities arrested seven people suspected of dealing buprenorphine, which is sold mainly as Suboxone. "I think [buprenorphine is]

Maryland health officials told state lawmakers yesterday that they were taking steps to minimize possible abuse of the addiction treatment buprenorphine as they spend millions to expand its availability. While insisting that misuse is currently not a serious problem, they outlined precautions in an appearance before a House of Delegates committee. These include screening for buprenorphine in overdose deaths, coordinating with police to monitor street sales and supporting a bill that would call for monitoring prescription drugs, including buprenorphine.

During the recent lame-duck session, Congress took a big step toward getting an effective antidote to heroin and other addictive substances within reach of more users by increasing the number of addicted patients that private doctors can treat with the promising drug buprenorphine. It's a welcome development for addicts across the country, but especially in Baltimore where the problem is so acute. Like methadone, buprenorphine is a synthetic opiate that has helped addicts kick the habit.

Baltimore's health commissioner told the city's top criminal justice leaders yesterday that his agency will do more to minimize street sales of buprenorphine, an addiction treatment drug for which the city and state are spending millions of dollars. Commissioner Dr. Joshua M. Sharfstein has said that misuse of the drug is not a public health problem, but that he will take specific action to reduce street sales - called diversion - as the city expands buprenorphine treatment. "It's available on the street," Sharfstein told the Baltimore Criminal Justice Coordinating Council at a presentation at the downtown courthouse.

By Peter Hermann and Peter Hermann,peter.hermann@baltsun.com | October 1, 2009

Marianne Woessner is a North Carolina nurse and midwife who sees drug addicts with good jobs and from good families nearly every day. They occupy a hidden world that belies the stereotype of rail-thin junkies stumbling from one street corner to the next in search of a fix. Woessner was the mother of one such drug addict. She made the discovery Sunday night, when a Baltimore police officer called to tell her that her daughter, Carrie Elisabeth John, died that evening after apparently injecting herself with buprenorphine while trying to get high with her boyfriend, Clinton Blaine McCracken, in their rented rowhouse near downtown.

By Nick Madigan and Nick Madigan,nick.madigan@baltsun.com | September 30, 2009

Clinton McCracken and Carrie John knew all about addictions and obsessive behavior. Both worked as postdoctoral research fellows at the University of Maryland School of Medicine and earlier this year published their conclusions from a study of "compulsions and habit formation." But their research might have taken too personal a turn. John, 29, a Wake Forest University graduate with a doctorate in physiology and pharmacology, died Sunday after apparently injecting herself with what McCracken called a "bad" batch of buprenorphine, a narcotic known on the street as "bupe" and commonly used to treat heroin addiction.

Baltimore has doubled the number of people using the medication buprenorphine to shake off heroin addiction but has struggled to keep them in treatment. As the Baltimore Buprenorphine Initiative has accepted more hard-core drug addicts dealing with complications such as mental illness, more drop out. At the start of the initiative in October 2006, officials had picked mostly highly motivated participants. The retention rate dropped to 52 percent for the year that ended June 30 compared with 65 percent in fiscal year 2007.

Buprenorphine arrests increase Police seizures of buprenorphine increased rapidly in Baltimore City and County in 2007, the same year that local and state government started spending millions to expand use of the narcotic to treat opiate addicts, police drug lab data show. Adkins named state adjutant general Gov. Martin O'Malley tapped the state secretary of veterans affairs, Brig. Gen. James A. Adkins, to be Maryland's adjutant general, a post that oversees - among other services - the state's Army National Guard and Air National Guard.

Police seizures of buprenorphine increased rapidly in Baltimore City and County in 2007, the same year that local and state government began spending millions to expand use of the narcotic to treat opiate addicts, police drug lab data show. The numbers provide evidence of growing illegal sales and abuse of buprenorphine, a trend seen nationally. This month in Wise County, Va., authorities arrested seven people suspected of dealing buprenorphine, which is sold mainly as Suboxone. "I think [buprenorphine is]

WASHINGTON -- Amid growing illegal sales and abuse of buprenorphine, top federal officials outlined yesterday action they might take to curb problems with the addiction-treatment drug, including more precise detection methods, improved training of doctors and stronger warning labels for patients. "The issue of diversion has been out there since 2004," said Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, which oversees the federal government's buprenorphine initiative.

Despite widespread acknowledgement of its effectiveness, a drug that counteracts heroin cravings has had limited availability. But there's a national push for greater use of the drug, and Maryland health officials are prudently on the bandwagon - and may offer some leadership as well. The drug is buprenorphine, a synthetic opiate that has proven to be an effective antidote to heroin as well as prescription painkillers such as Oxycontin. Prescribing the drug and managing its use can be done through individual doctors, teaching hospitals, community health centers and group practices.

The number of heroin addicts receiving a revolutionary drug that is safer than methadone could triple under pending federal legislation -- a change that Baltimore health care advocates say could help the city combat addiction. Physicians would be allowed to prescribe buprenorphine, commonly known as "bupe," to 100 patients -- up from the current 30-patient limit. Unlike methadone, bupe is taken at home and is less prone to abuse. Easing buprenorphine regulations will boost an initiative crafted this year by City Hall to train more doctors to prescribe the drug.

The federal agency that oversees buprenorphine treatment for narcotics addicts learned more than two years ago of illegal sales and abuse of the pills but did not reveal the findings as officials campaigned to expand use of the drug. U.S. Substance Abuse and Mental Health Services Administration records show that in December 2005, Vermont health officials advised the federal agency of some patients crushing and injecting the pills called Suboxone, trading or peddling them on the street -- even smuggling them into the state's prisons.

Alarmism distorts the value of `bupe' There are two separate conversations occurring in Baltimore on buprenorphine, a highly effective medication for heroin addiction. In one conversation, The Sun's news pages are expressing alarm about illegal sales of buprenorphine. This reporting has lacked context and balance. The Sun's most recent story, for example, highlights several concerns from a 70-page report on buprenorphine diversion prepared for the manufacturer by an expert consultant ("Misuse of `bupe' is found to be on rise," Feb. 3)